Abstract
Evidence for the effectiveness of patient education programmes in changing individual self-management behaviour is equivocal. More distal elements of personal social relationships and the availability of social capital at the community level may be key to the mobilisation of resources needed for long-term condition self-management to be effective.AimTo determine how the social networks of people with long-term conditions (diabetes and heart disease) are associated with health-related outcomes and changes in outcomes over time.MethodsPatients with chronic heart disease (CHD) or diabetes (n = 300) randomly selected from the disease registers of 19 GP practices in the North West of England. Data on personal social networks collected using a postal questionnaire, alongside face-to-face interviewing. Follow-up at 12 months via postal questionnaire using a self-report grid for network members identified at baseline.AnalysisMultiple regression analysis of relationships between health status, self-management and health-economics outcomes, and characteristics of patients' social networks.ResultsFindings indicated that: (1) social involvement with a wider variety of people and groups supports personal self-management and physical and mental well-being; (2) support work undertaken by personal networks expands in accordance with health needs helping people to cope with their condition; (3) network support substitutes for formal care and can produce substantial saving in traditional health service utilisation costs. Health service costs were significantly (p<0.01) reduced for patients receiving greater levels of illness work through their networks.ConclusionsSupport for self-management which achieves desirable policy outcomes should be construed less as an individualised set of actions and behaviour and more as a social network phenomenon. This study shows the need for a greater focus on harnessing and sustaining the capacity of networks and the importance of social involvement with community groups and resources for producing a more desirable and cost-effective way of supporting long term illness management.
Highlights
Strategies for self-management focused on increasing patients’ self-efficacy are often a key element of health policy for managing long term conditions
Findings indicated that: (1) social involvement with a wider variety of people and groups supports personal selfmanagement and physical and mental well-being; (2) support work undertaken by personal networks expands in accordance with health needs helping people to cope with their condition; (3) network support substitutes for formal care and can produce substantial saving in traditional health service utilisation costs
This study shows the need for a greater focus on harnessing and sustaining the capacity of networks and the importance of social involvement with community groups and resources for producing a more desirable and cost-effective way of supporting long term illness management
Summary
Strategies for self-management focused on increasing patients’ self-efficacy are often a key element of health policy for managing long term conditions. Patients taking on more responsibility for their health behaviours together with guided support and training has been viewed as a means of improving health outcomes and reducing the costs of health service utilisation[1,2,3]. In response to equivocal evidence of the effectiveness of patient education programmes designed to change individual behaviour[4] it has been suggested that more distal elements related to social relationships and the availability of social capital at the community level may be key to the mobilisation of resources needed to take self-management action [5]. Low stocks of social capital, both at the community and individual levels, have been consistently shown to be strongly associated with poorer health outcomes [16,17]
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